Primary care’s eroding earnings: Is Congress concerned?

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Original Research

Primary care’s eroding earnings: Is Congress concerned?

J Fam Pract. 2008 September;57(9):578-583

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References

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The Medical Home is a concept gaining recognition among congressional staff and could involve restructured physician payment. In its Tax Relief and Health Care Act of 2006, Congress mandated a 3-year Medical Home demonstration to be conducted across multiple demographic communities in up to 8 states. The concept encompasses “large or small medical practices where a physician provides comprehensive and coordinated patient centered medical care and acts as the ‘personal physician’ to the patient.”²⁵ (The Medical Home is also a focus of The Patient-Centered Primary Care Collaborative [http://www.pcpcc.net/], a coalition of medical societies, employers, insurers, consumer groups, and others that is exploring the concept as a way to contain health care costs and also achieve fair remuneration for physicians.)

The demonstration must be carefully crafted to test the concept fairly. Even before the demonstration begins, Congress could ask the CBO and GAO to investigate existing evidence of primary care’s cost-effectiveness. Support from the CBO is essential for Congress to invest in primary care.

Other experiments are underway. As of this publication, several major insurers are beginning regional experiments in raising fees for primary care visits in an effort to avoid greater costs down the road.²³

Access issue needs further study. Our interviews revealed that while MedPAC asserts there is no primary care access issue, staffers from rural districts disagree. In fact, had Congress not over-ridden President Bush’s recent veto of a Medicare bill to increase physicians’ fees, doctors in urban areas would also have stopped accepting new Medicare patients.²⁶ Additional physician workforce studies are necessary to fully understand the current primary care physician supply. Also useful would be studies by Medicaid and Medicare that investigate thresholds at which physicians stop seeing patients with low-paying coverage.

Advocacy is needed, too. Congressional staffers appear to understand some of the difficulties in primary care, but give priority to broader SGR reform. Further research and advocacy on the value of primary care and payment reform solutions will be necessary to establish primary care as a means to cost-effective, high-quality care in the United States.

Acknowledgment

Part of the content in this article was presented as a poster at the North American Primary Care Research Group Conference in Vancouver, British Columbia, October 2007.

Correspondence
Brian Yoshio Laing, MD, San Francisco General Hospital, 995 Potrero Avenue, Building 80, Ward 83, San Francisco, CA 94110; yoshi.laing@ucsf.edu.